On hallway medicine............
Some of the required investments, are medium-term or longer, as noted, such as more long-term care beds.
Though, that's largely discussing ERs of course.
There are a variety of other investments/changes that government could make, a quite a few are straight-forward enough.
Its merely that a) they cost money; b) change is always difficult and will invariably ruffle a few feathers.
Let me provide a couple of examples.
I had occasions to find myself in an ER recently, in wee hours of the morning.
The matter was suited to what you might call a 'green zone' or 'ambulatory'' ER treatment, as opposed to main Emerg.
There actually weren't that many people waiting at that time; perhaps 3 when I arrived.
Not one person was seen during the next 4 hours.
Reason: The ambulatory or non-complex side of this ER at a major, downtown Toronto teaching hospital was closed until 8am. They wouldn't entertain seeing those types of cases on the main Emerg side with only one doctor working.
The result, by the time the easy-case wing opened, the line of people was 14 deep and with standees.
The simple choice to have one more doctor on overnights and likely open an extra nursing station with a minimum of 2 nursing staff, would have eliminated this issue.
Of course, that costs money; but actually surprisingly little in the context of a major hospital budget. I know, as I had a follow up conversation with hospital management.
The cost of opening the additional ER space for an extra six hours per day was estimated at about $700,000 per year. This hospital has a budget roughly 1000x that size.
The real issue had to do with compelling doctors to work the shift in question, not the money. So a funding increase of 0.1%, which scaled to other hospitals in the province which operate similarly would cost something like $20M per year or 0.04% of health spending in Ontario.
Its hardly the only problem of its type.
In respect of ERs a shift in triage philosophy was piloted at different hospitals in which a physician assessed everyone who came into the ER within 20 minutes.
This did not involve a material increase in resources, but rather a reduction in nurse/orderly staff and an increase of 1 doctor.
The intent was to remove anyone who could be quickly assessed and sent home, with or without prescriptions/stitches etc.
The result, far few beds occupied by people awaiting assessment, which in turn means no one on a stretcher without a room.
In the test, the results were resoundingly positive in smaller hospitals; with about 80% success in larger teaching environments.
It was only the in the latter case, where the absence of LTC beds periodically (about 1 day out of 5) caused a back-up into the ER as patients who needed to be admitted to the hospital could not be.
Despite that success, and a clear instruction on where to prioritize change, the province has not rolled this pilots out.